Mineral trioxide aggregate (MTA) has been used for more than 10 years in the dental community and has often been thought of as a material of choice for the endodontist. The dental pulp is closely related to periodontal tissues through apical foramina, accessory canals, and dentinal tubules. Due to this interrelationship, pulpal diseases may influence periodontal health and periodontal infections may affect pulpal integrity. It is estimated that pulpal and periodontal problems are responsible for more than 50% of tooth mortality. Thus, these associations recommend an interdisciplinary approach. MTA appears to exhibit significant results even in periodontal procedures as it is the first restorative material that consistently allows for over-growth of cementum and may facilitate periodontal tissue regeneration. Thus, in the present review, an attempt is made to discuss the clinical applications of MTA as an interdisciplinary approach.

The microbial etiology of periodontal disease has been the focus of researchers for a long time. The search for the pathogens of periodontal diseases has been underway for more than 100 years, and continues up today. Despite the increasing knowledge about oral microbiota, we are not able to implicate any one particular organism that can be considered as a candidate pathogen. In fact the term "candidate pathogen" has lost its steam with a myriad of microorganisms being incriminated from time to time. Most studies of the bacterial etiology of periodontitis have used either culture-based or targeted deoxyribonucleic acid approaches and so it is likely that pathogens remain undiscovered. The advent of 16S cloning and sequencing has facilitated identifi cation of several uncultivable bacteria in the oral cavity. The concept that not one single organism, but several organisms contained in the biofi lm orchestrating in a medley of the show appears to be more plausible. The present review highlights some lesser known bacteria associated with periodontal destruction.

Background: Obesity is a chronic inflammatory condition that has been associated to a risk factor for the development of periodontitis and cardiovascular disease; however, the relationship still needs to be clarified. The objective of this study was to evaluate the cardiovascular risk in obese patients with chronic periodontitis. Materials and Methods: A total of 87 obese patients were evaluated for anthropometric data (body mass index [BMI], waist circumference, body fat), systolic blood pressure (SBP) and diastolic blood pressure (DBP), cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglycerides, glycemia and periodontal parameters (visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment level (CAL)). Results: Patients were divided into two groups according to the periodontal characteristics found: Group O-PD: Obese patients with chronic periodontitis (n = 45), 22 men and 23 women; and Group O-sPD: Obese patients without chronic periodontitis (n = 42), 17 men and 25 women. Patients had a BMI mean of 35.2 (±5.1) kg/m 2 . Group O-PD showed a similarity between the genders regarding age, SBP, DBP, cholesterol, HDL, GBI, VPI, PPD ≥4 mm and CAL ≥4 mm. O-PD women showed greater glycemia level and smoking occurrence, but O-PD men presented a 13% - risk over of developing coronary artery disease in 10 years than O-PD women, 9% - risk over than O-sPD men and 15% - risk over than O-sPD women, by the Framingham Score. Conclusions: It was concluded that obesity and periodontal disease are cardiovascular risk factors and that the two associated inflammatory conditions potentially increases the risk for heart diseases.

Background: In India, anemia is a common and serious health disorder among both sexes and all age groups, with anemia of chronic disease (ACD) being the second most prevalent anemia. Periodontitis is an inflammatory disease of the supporting tissues of the tooth caused by specific microorganisms. An immune response to bacteria and their products induces a major vascular response, offering explanatory mechanisms for the interactions between periodontal infection and a variety of systemic disorders. Therefore, periodontitis results in low-grade systemic inflammation, which may cause lower number of erythrocytes and, consequently, lower hemoglobin concentration. Materials and Methods: A total of 100 systemically healthy male patients visiting the outpatient department participated in the study. Of these, 50 patients had healthy periodontium and 50 patients had chronic periodontitis. Clinical parameters and red blood cell parameters of all the patients were assessed at baseline and 6 months after non-surgical periodontal therapy. Statistical analysis using Student's t-test was performed. Results: Data analysis revealed that patients with chronic periodontitis showed an improvement in both clinical and red blood cell parameters from baseline to 6 months after non-surgical periodontal therapy. Conclusion: From the present study, it can be concluded that like any other chronic condition, chronic periodontitis can lead to ACD. It also provides evidence that non-surgical periodontal therapy can improve the anemic status of patients with chronic periodontitis.

Background: Fluorosis causes mineralization changes in the tooth and can lead to morphologic alterations of fibroblasts. To understand the effect of fluorosis on periodontal healing, the initial step during healing, such as fibroblast attachment to the root surface, needs to be evaluated. Hence, the objective of the present study was to study the attachment of fluorosed fibroblasts on the fluorosed and nonfluorosed root fragments. Materials and Methods: A total of 56 fluorosed and nonfluorosed, periodontally healthy and diseased tooth roots were obtained and allotted to eight groups: Fluorosed and nonfluorosed healthy controls (FH and NFH, respectively), fluorosed and nonfluorosed diseased controls (FD and NFD, respectively), fluorosed and nonfluorosed roots treated with scaling and root planing (FD + S and NFD + S, respectively), and similar groups treated with scaling and root planing and 24% ethylenediaminetetraacetic acid (EDTA) gel application for 2 min (FD + SE and NFD + SE, respectively). After the respective treatment, the root fragments were incubated in the human periodontal ligament fibroblast cells obtained and cultured from freshly extracted healthy human fluorosed premolar tooth root. Results: In the nonfluorosed roots category, greater attachment was found in the untreated nonfluorosed diseased (P = 0.036) and SRP-treated nonfluorosed diseased groups (P = 0.008) as compared to the nonfluorosed healthy group. While in the fluorosed roots category, no significant difference was observed in FL-FA (P > 0.05) within the group. However, no attachment was observed in EDTA-treated fluorosed root fragments. When fluorosed groups were compared to nonfluorosed groups, no significant changes were noted between the groups. Conclusion: SRP proves to be a standard requirement for fibroblast attachment to occur both in fluorosed and nonfluorosed roots. Although there was no significant difference in attachment between SRP and SRP + EDTA among fluorosed roots, EDTA does not seem to be a promising agent for root biomodification in fluorosed roots in a given concentration and time of treatment.

Background: A surface smear layer consisting of organic and inorganic material is formed on the root surface following mechanical instrumentation and may inhibit the formation of new connective tissue attachment to the root surface. Modification of the tooth surface by root conditioning has resulted in improved connective tissue attachment and has advanced the goal of reconstructive periodontal treatment. Aim: The aim of this study was to compare the effects of citric acid, tetracycline, and doxycycline on the instrumented periodontally involved root surfaces in vitro using a scanning electron microscope. Settings and Design: A total of 45 dentin samples obtained from 15 extracted, scaled, and root planed teeth were divided into three groups. Materials and Methods: The root conditioning agents were applied with cotton pellets using the "Passive burnishing technique" for 5 minutes. The samples were then examined by the scanning electron microscope. Statistical Analysis Used: The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows). For all quantitative variables means and standard deviations were calculated and compared. For more than two groups ANOVA was applied. For multiple comparisons post hoc tests with Bonferroni correction was used. Results: Upon statistical analysis the root conditioning agents used in this study were found to be effective in removing the smear layer, uncovering and widening the dentin tubules and unmasking the dentin collagen matrix. Conclusion: Tetracycline HCl was found to be the best root conditioner among the three agents used.

Background: Gingival recession defects (GRD) are one of the most commonly encountered conditions for which periodontal treatment is required. Several attempts have been made to classify GRD. Among all the classifications Millers classification for gingival recessions is the most accepted. Recently, several limitations and drawbacks have been pointed out in Miller's classification system. The aim of the present study is to test the reliability of the recently proposed Mahajan's Modification of the Miller's Classification for GRD. Materialsand Methods: All 15 males and 11 females between the ages of 22 and 55 years (mean age, 37.15 year) with at least one buccal gingival recession were consecutively recruited by the same periodontist in order to test the reliability of the new classification of GRD. The classification was tested by two examiners blinded to the data collected by the other examiner. Intra-rater and inter-rater agreement was assessed. Results: The new classification system of gingival recessions was tested in a total of 175 gingival recessions in 26 patients. The intraclass correlation coefficient for inter-rater agreement was 0.90, showing an almost perfect agreement between the examiners. Conclusion: The newly proposed classification system eliminates the drawbacks and limitations associated with Miller's classification system and can be used to classify GRD reliably.

Background: The gingival morphology of the maxillary anterior region plays an important role in determining the final esthetic outcome. Knowledge of the periodontal biotype is of fundamental importance because the anatomical characteristics of the periodontium, such as gingival thickness, gingival width and alveolar bone morphology, will determine periodontium behavior when submitted to physical, chemical, or bacterial injury or during periodontal or implant surgical procedures and orthodontic treatment. MaterialsandMethods: 50 subjects with healthy periodontal tissues with no loss of attachment and (b) presence of all anterior teeth in both upper and lower jaw were selected. On clinical examination gingival thickness was recorded based on the transparency of periodontal probe. Following parameters are recorded from dental cast, i.e., crown length, crown width, papillary length (PL) and papillary width. Results: There was highly significant correlation between gingival biotype and crown length and area of papilla with P value −0.002 and 0.013 respectively. Significant correlation was found between area of crown and PL with P value −0.013 and 0.016. The results of discriminant function analysis showed that average crown length was the best single determinant of biotype and area of papilla was the next best choice. Conclusion: Within the limits of the current investigation, the existence and correlation of different gingival biotypes and dentopapillary complex dimension has been confirmed. These findings can be utilized as objective guidelines for determining the biotype and response of gingiva to many dental operative procedures.

Background: Ayurvedic drugs have been used since ancient times to treat diseases including periodontal diseases. Oral rinses made from ayurvedic medicines are used in periodontal therapy to control bleeding and reduce inflammation. The aim of this clinical study is to verify the efficacy of herbal mouthwash containing Pilu, Bibhitaka, Nagavalli, Gandhapura taila, Ela, Peppermint satva, and Yavani satva on reduction of plaque and gingivitis. Materials and Methods: A total of 100 volunteers with clinical signs of mild to moderate gingivitis were selected and assigned to Group A (only scaling done) and Group B (scaling along with the use of herbal mouthwash). After recording the clinical parameters, the patients were instructed to use herbal mouthwash 15 ml for 30 s twice daily after food in Group B and oral hygiene instructions were given to all patients. Plaque and gingivitis assessment were carried out using the plaque index (Silness nd Loe, 1964), Gingival index (Loe And Silness, 1963), Gingival bleeding index (Ainamo and Bay, 1975) at baseline and at 21 days of the herbal mouthwash use. Statistically analysis was carried out using the student's t-test for normally distributed data and Wilcoxson test or Mann-Whitney U-test for skewed data. Results: Our results showed that herbal mouthwash was effective in treatment of plaque induced gingivitis in Group B when compared with the Group A. Conclusion: Herbal mouthwash is effective in treatment of plaque induced gingivitis and can be effectively used as an adjunct to mechanical therapy with lesser side-effects.

Context: Saliva can be used as a diagnostic fluid in dentistry. Various enzymes have been proposed as markers for periodontal destruction. One of them is aspartate aminotransferase, for which salivary analysis can offer a cost-effective approach for monitoring the disease. Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium in inflammation. Aims: The purpose of this study was to assess the aspartate aminotransferase levels in saliva prior to and following scaling and root planning (SRP) at 1 month and 3 month interval and correlating it with the clinical parameters in generalized chronic gingivitis and chronic periodontitis patients. Materials and Methods: Thirty patients with generalized chronic gingivitis and 30 with generalized chronic periodontitis were selected. The activity of aspartate aminotransferase levels in saliva were assessed biochemically before and after SRP at 1 month and 3 months. The aspartate aminotransferase levels were correlated with clinical parameters (gingival index and probing depth). Statistical Analysis Used: A paired t test was done. Results: A decrease in gingival index, probing depth, and aspartate aminotransferase levels were seen in both the groups at 1 and 3 months which was found to be statistically highly significant (P value 0.00). Aspartate aminotransferase levels were statistically significantly correlated with the clinical parameters at baseline (P < 0.05) but at 3 months, a positive correlation was seen in both the groups which was statistically insignificant (P > 0.05). Conclusions: Elevated salivary aspartate aminotransferase levels were seen in generalized chronic gingivitis and chronic periodontitis patients, with higher values recorded in generalized chronic periodontitis correlating to the tissue destruction taking place in these conditions.

Comparative evaluation of the efficacy of the cyclooxygenase pathway inhibitor and nitric oxide synthase inhibitor in the reduction of alveolar bone loss in ligature induced periodontitis in rats: An experimental study

Background: Alveolar bone loss is the most striking feature of periodontal disease. The aim of this study was to investigate the effect of a cyclooxygenase (COX) pathway inhibitor and nitric oxide synthase (NOS) inhibitor in the reduction of alveolar bone loss in an experimental periodontal disease (EPD) model. Materials and Methods: The study was conducted on 60 Wistar rats divided into three groups of 20 rats each and then subjected to a ligature placement around the left maxillary second molars. Group 1 rats were treated with COX inhibitor (diclofenac sodium 10 mg/kg/d), group 2 with NOS inhibitor (aminoguanidine hydrochloride 10 mg/kg/d) and group 3 served as controls, receiving only saline, intraperitoneally 1h before EPD induction and daily until the sacrifice on the 11 th day. Leukogram was performed before ligation, at 6 h and at the first, seventh and 11 th days after EPD induction. After sacrifice, all the excised maxillae were subjected to morphometric and histometric analysis to measure the alveolar bone loss. Histopathological analysis was carried out to estimate cell influx, alveolar bone and cementum integrity. Results: Induction of experimental periodontitis in the rat model produced pronounced leucocytosis, which was significantly reduced by the administration of diclofenac sodium and aminoguanidine on the 11 th day. In morphometric and histometric examinations, both the test drugs significantly (P < 0.05) inhibited the alveolar bone loss as compared with the control group. Conclusion: Both COX inhibitor and NOS inhibitor are equally effective in inhibiting the inflammatory bone resorption in an experimental periodontitis model.

Background: Biostatistics is an integral part of research protocols. In any field of inquiry or investigation, data obtained is subsequently classified, analyzed and tested for accuracy by statistical methods. Statistical analysis of collected data, thus, forms the basis for all evidence-based conclusions. Aim: The aim of this study is to evaluate the cognition, comprehension and application of biostatistics in research among post graduate students in Periodontics, in India. Materials and Methods: A total of 391 post graduate students registered for a master's course in periodontics at various dental colleges across India were included in the survey. Data regarding the level of knowledge, understanding and its application in design and conduct of the research protocol was collected using a dichotomous questionnaire. A descriptive statistics was used for data analysis. Results: Nearly 79.2% students were aware of the importance of biostatistics in research, 55-65% were familiar with MS-EXCEL spreadsheet for graphical representation of data and with the statistical softwares available on the internet, 26.0% had biostatistics as mandatory subject in their curriculum, 9.5% tried to perform statistical analysis on their own while 3.0% were successful in performing statistical analysis of their studies on their own. Conclusion: Biostatistics should play a central role in planning, conduct, interim analysis, final analysis and reporting of periodontal research especially by the postgraduate students. Indian postgraduate students in periodontics are aware of the importance of biostatistics in research but the level of understanding and application is still basic and needs to be addressed.

Background: Schizophrenia is a psychosis characterized by delusions and hallucinations occurring in clear consciousness. Studies have shown that the cytokines may modulate dopaminergic metabolism and schizophrenic symptomatology in schizophrenia. Cytokine involvement in periodontal disease is also well documented. To date, however, there has been relatively little research assessing periodontal status of patients with schizophrenia. The present study was therefore mainly intended to understand the exact link, if any, between periodontal disease and schizophrenia. Materials and Methods: A total of 250 schizophrenic patients (140 males and 110 females), between 25 and 55 years of age, were selected from the out patient department of National Institute of Mental Health and Neural Sciences, Bangalore and their periodontal status was assessed as part of this cross-sectional epidemiological survey. Results: ANOVA showed that there was increased evidence of poor periodontal condition, as evidenced by gingival index and plaque index in patients who had been schizophrenic for a longer duration of time (P < 0.001). So also, higher probing pocket depths were found in schizophrenics suffering from a longer period of time than others (P < 0.001). Conclusions: Although oral neglect might be a cause of poor periodontal health in schizophrenics, the possible link between periodontal diseases giving rise to schizophrenia cannot be overlooked due to the presence of cytokine activity which is present both in schizophrenia and periodontal disease.

Background: The prison population is a challenging one with many health problems, including oral health. In a country like India the information regarding the status of periodontal health in prisoners is scant. Aim: To assess the periodontal status of the jail inmates at Mangalore District Jail. Materials and Methods: Cross sectional survey Participants: A Randomly selected sample of 82 male inmates of age group 18-60 years were examined using community periodontal index (CPI) and loss of attachment from modified WHO oral health assessment proforma (1997). Results: The prevalence of periodontal disease was 97.5%. Majority of the study population had CPI score of 2 and 1. Majority of the prisoners were severely affected with loss of attachment with 35% had loss of attachment more than 3 mm. Conclusion: As there are no oral health care facilities available in the prison set up, this study emphasizes the need for special attention from government and voluntary organizations to provide the oral health care services to inmates and improve the overall health status of the prisoners.

Objective: To assess the general knowledge of Nigerian dentists on aggressive periodontitis (AgP) and specific knowledge of distinguishing between the clinical features of localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP). Materials and Methods: A cross-sectional, non-random convenience survey was done on 200 dentists, in three geopolitical zones of Nigeria, using pre-tested, closed question– type questionnaires. Eventually, only 133 questionnaires were analyzed. Relationships between six outcome variables namely clinical features of LAP, clinical features of GAP, LAP oral hygiene, GAP oral hygiene, laser therapy option and type of laser therapy, and the explanatory variables of gender and experience were analyzed. Results: A total of 33.8% of the dentists had poor general knowledge, 16.5% had fair knowledge, 31.9% had good knowledge, while 10.5% had excellent knowledge. Gender- and experience-related differences were found, but they were not statistically signifi cant. Conclusion: Both the general and specifi c knowledge of aggressive periodontitis among Nigerian dentists is less than expected and needs improvement through targeted, continuing dental education.

Post-operative complications following flap surgeries or mucogingival procedures are important factors influencing patient's perception of periodontal procedures. Hence, it is important to foresee such complications and take adequate measures pre- and post-operatively. We treated five consecutive cases of gingival recession in the maxillary canine-premolar area using the inverted periosteal graft with a coronally positioned flap technique. Following each of these surgeries, the patients complained of post-operative swelling the next day involving the canine space or buccal space area. The swelling persisted for at least 5 days, however, it was painless. This paper highlights the post-operative complications associated with the said procedure and makes a case for detail enquiry in the form of controlled studies.

Central odontogenic fibroma World Health Organization (WHO)-type (OFWT) is a rare lesion that has differential diagnosis with other radiolucent periapical lesions. It has a slow growth and is usually an asymptomatic lesion found in routine examinations. We report a case of a central OFWT occurring in the maxilla, for which the first symptom was teeth mobility, simulating a periodontal condition. A 54-year-old woman, with superior premolar mobility, was referred to our clinic. An oral examination showed teeth vitality and advanced periodontal disease. Radiography showed a unilocular radiolucent area between the left superior lateral incisor and first left molar, with bone reabsorption. The granulomatous tissue was removed and microscopic examination revealed cellular connective tissue with multiple islands of odontogenic epithelium, covered by stratified squamous epithelium, confirming the OFWT diagnosis. The central OFWT is a non-aggressive lesion, with rare recidivism. Biopsy is an important procedure for correct diagnosis and treatment, as some radiolucent lesions can lead to misdiagnosis.

The peripheral ossifying fibroma (POF) is a benign reactive gingival overgrowth; it occurs mainly in the anterior portion of maxilla in young adults, predominantly among females. The present report describes a case of POF in a male patient, which relapsed ten years later and of the lesion showed superficial bone erosion on surgical excision.

Gingival enlargement, the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Local and systemic factors influence the gingival conditions of the patient. These factors results in a spectrum of diseases that can be developmental, reactive and inflammatory to neoplastic. In this article, the history, etiology, clinical and histopathological features, treatment strategies and preventive protocol of inflammatory hyperplasia are discussed.

Leukemia is a neoplastic disease characterized by an excessive proliferation of immature white blood cells and their precursors. Oral lesions may be the presenting feature of acute leukemia, which can be rapidly fatal if left untreated. Although many cases of gingival enlargement in patients with acute myeloid leukemia's have been reported in the literature, cases diagnosed by the oral manifestations in India are very few. This report describes the case of a 43-year-old female who presented with gingival bleeding and gingival enlargement. Within a month she developed signs and symptoms of systemic disease such as, and splenomegaly, and upon further investigation, she was diagnosed with acute myeloid leukemia to which she succumbed within 10 days after diagnosis. The need for early diagnosis and referral of this fatal disease are also underline.

A 47-year-old male patient reported to the Department of Periodontology, with a chief complaint of pus discharge from maxillary left central incisors with dull intermittent pain. On clinical examination, a localized gingival inflammation was present with soft edematous tissue with the accumulation of plaque and calculus with #11 and #21. Periodontal examination depicts a periodontal pocket depth of 11 mm on mesial aspect and 8 mm on midbuccal aspect of #21 with no mobility. On radiographic examination, a tear-shaped radiolucency was present with localized bone loss in #21. On careful examination, labial-cervical-vertical groove (LCVG) was found on #21 which was extending into gingival sulcus. This article reports the effectiveness of platelet rich fibrin for the treatment of intrabony defect associated with labial-cervical-vertical groove of #21.

Various plastic procedures are done to enhance esthetics, relieve hypersensitivity or even prevent root caries. The most predictable plastic procedure is the coronally advanced flap procedure, with subepithelial connective tissue. Owing to the second surgical donor site and difficulty in procuring a sufficient graft in multiple recessions, various alternative additive membranes are used. This is a case report, the first of its kind, wherein a bilaterally occurring multiple Millers class I recession was managed by using Platelet-rich Fibrin (PrF) and amniotic membrane, in a 40-year-old male, who presented to the Department of Periodontics. He complained of hypersensitivity in relation to the upper right and left back region, a bilateral Millers class I recession in relation to 15, 16, and 25, 26 of 3 mm each. Both the recessions were planned for root coverage with coronally advanced flap and additive membrane. The sites were randomly assigned for the use of platelet-rich fibrin and an aminotic membrane. The clinical outcome of the surgical procedure accounted for 100% root coverage, an enhanced gingival biotype, with both the membranes. Furthermore, the results were stable even after seven months in the amniotic membrane-treated site. Hence, the use of amniotic membrane as a novel approach to root coverage is more advantageous than PrF owing to the laboratory preparation of the autologous biomaterial.

Rehabilitation of severely atrophied maxillae is often a challenge and patients with generalized aggressive periodontitis (GAP) make it even more complicated. This clinical report describes rehabilitation of GAP patients with zygomatic implants and followed-up for 2 years. Two patients of age 33 and 44 reported to a private dental practice and were diagnosed with GAP. Various treatment options were considered after which it was decided to do a full mouth implant supported fixed rehabilitation, with a combination of conventional and zygomatic implants. Two zygomatic and four conventional implants were placed and immediately loaded with a provisional prosthesis. After 6 months, definitive prosthesis was delivered. Implants and prostheses were followed-up for 2 years. No implant failures occurred, but a few biological complications were observed. The most common clinical observation in these patients during recall visits was peri-implant soft-tissue inflammation, which is a biological complication. This was with no trouble, controlled by using proper oral hygiene aids and maintenance. Within the limitations of this study, we can state that it can definitely be considered as a viable treatment option treating patients with GAP. However, studies with more follow-up time and controlled clinical trials should be performed in order to document the longevity of this treatment modality.

Throughout history, education has evolved, and new teaching/learning methods have been developed. These methods have helped us come a long way in understanding the pathogenesis, diagnosis, and treatment of diseases of the oral cavity. However, there is still no one good way to render a student/clinician the tactile sense for detecting calculus/caries or placing the incisions or detecting the smoothness of a restoration or any treatment procedures before entering the clinics. In the education field, to improve the tactile sensation, the sense of touch and force-feedback can offer great improvements to the existing learning methods, thus enhancing the quality of education procedures. The concept of Haptics, which is extensively in use and indispensable in other fields like aviation, telecommunication etc., is now making its way into dentistry. Against this background, the following write-up intends to provide a glimpse of the coming wave of Haptics - A virtual reality system in dental education and discusses the strengths and weak points of this system.